Individual
MRS. TILLY BURROUGHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP, PMHNP-BC
Contact information
Practice address
1010 35TH ST, KENOSHA, WI 53140-1902
(262) 725-4426
(262) 299-7136
Mailing address
1010 35TH ST, KENOSHA, WI 53140-1902
(262) 725-4426
(262) 299-7136
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
13216-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
13216-33
WI
Other
Enumeration date
08/01/2022
Last updated
03/17/2025
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